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National Mobile Health Insurance Programme Benefits Package.

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Presentation on theme: "National Mobile Health Insurance Programme Benefits Package."— Presentation transcript:

1 National Mobile Health Insurance Programme Benefits Package

2  Health preventive, promotive and rehabilitative services such as health education, immunization, counseling and testing for HIV/AIDS, etc  Access to care for defined medical and surgical conditions, covering consultation, laboratory investigations, pharmaceuticals, etc.  Essential pharmaceuticals from NHIS accredited pharmacy providers including provision of needed pharmaceutical care from pharmacists (beneficiaries to pay 10% of the cost of pharmaceuticals as co-payment) All drugs are generics as contained in the essential drug list of the FMoH  Routine laboratory investigations  Maternal and child health services  Primary eye care, dental and mental health services  Accident and Emergency services PRIMARY BENEFITS PACKAGE

3  Incision and drainage of abscess (I&D)  Wound debridement  Repair of lacerations  Circumcision of male infants  Drainage of Paronychia  Evacuation of impacted faeces  Correction of simple polydactyl Primary Surgery Services

4  Malaria and other acute febrile illnesses that can be managed at the primary level of care  Diarrhoel diseases  Acute respiratory tract infections  Urinary tract infections  Simple skin diseases such as T. Vesicolor, T. Capitas, M. Furfur, etc.  Worm infestation (Helminthiasis)  Other uncomplicated bacterial, fungal, parasitic and viral illnesses  Diagnosis and follow-up management of hypertension  Follow up management of Diabetes, Asthma, Sickle Cell Anaemia, Glaucoma, etc  Arthritis and other musculoskeletal disorders  Dog bite, Snake bite, Scorpion sting, etc.  Voluntary Counseling and Testing for HIV/AIDS and the treatment of opportunistic infections  Management of uncomplicated mental illnesses such as insomnia, anxiety neurosis, etc  Management of acute Pelvic inflammatory disease and vaginosis  Routine Antenatal care, delivery & postnatal care for low risk pregnancies (2 nd 3 rd & 4 th pregnancies)  Health education on family planning services (Safe period, condoms, pills, implant, etc)  Treatment of minor eye ailments, including conjunctivitis, simple contusion, abrasions, etc Primary Medical Services

5 Management of emergencies should aim at stabilization at the primary level of care before referral. Common conditions/procedures under emergency care include but not limited to:  Management of convulsions, coma, etc  Management of asthmatic attack  Management of sickle cell crisis  Management of shock  Simple tracheostomy  Control of bleeding  Cardio-respiratory resuscitation  Immobilization of fractures (using splints, neck collars, etc) Emergency Care

6  An infant to a registered mother is covered for a period of 12 weeks after delivery  Health education, growth monitoring, nutritional advice and routine immunization services  Management of childhood vaccine preventable illnesses  Malaria and other acute febrile illnesses that can be managed at the primary level of care  Diarrhoel diseases  Acute respiratory tract infections  Urinary tract infections  Simple skin diseases such as T. Vesicolor, T. Capitas, M. Furfur, etc.  Worm infestation (Helminthiasis)  Other uncomplicated bacterial, fungal, parasitic and viral illnesses  Management of Asthma, Sickel Cell Anaemia  Dog bite, Snake bite, Scorpion sting, etc  Nutritional disorders Primary Paediatric Services

7  Consultation with specialists and specialist care for Medicine, Surgery, Psychiatry, Obstetrics & Gygnaecology, ENT, Ophthalmology and Paediatrics  Hospitalization in general ward for a cumulative period of a maximum of 21 days per annum  Physiotherapy for restoration and rehabilitation  Medical imaging (radiology, ultrasonography, etc.)  Diagnostic laboratory services not covered at the primary level  Prescribed pharmaceuticals (generics) on the essential drug list of the FMoH SECONDARY SERVICES

8 Services at this level include consultation with specialist physician. All medical cases that cannot be handled at the primary level are managed at the secondary/tertiary level upon referral. These include but not limited to:  Complicated Hypertension and diabetes  Management of stroke, including hospitalization  Management of Chronic liver disease, Heart failure, Complicated respiratory tract infections,  Management of allergies and other complicated skin conditions  Management of HIV/AIDS requiring admission, including treatment of opportunistic infections. Secondary Medical Services

9 Benefits at this level include consultation with specialist surgeon and all surgical procedures not covered at the primary level and not in the exclusion list, such as :  Appendicectomy, herniorhapy, hydrocelectomy, splenectomy, removal of renal stones, prostatectomy, gall bladder surgeries, peptic ulcer surgeries, etc  Orthopaedic surgeries, including management of fractures.  Insertion of chest tubes, etc  Provision of locally made prosthesis Secondary/Tertiary Surgical Services

10 Benefits at this level include consultation with a Paediatrician. All paediatric medical conditions that cannot be handled at the primary level and are not on the exclusion list are managed at the secondary/tertiary level upon referral. These include but not limited to:  Neonatal incubation services for a maximum period of 12 weeks  Phototherapy & exchange blood transfusion services  Management of simple congenital anomalies such as cleft lip and cleft palate, etc  Management of complicated infections and infestations such as severe malaria, meningitis, pneumonia, etc.  Management of failure to thrive  Management of palsies  Management of allergies and other complicated skin conditions  Management of HIV/AIDS requiring admission Secondary/Tertiary Paediatric Services

11  Specialist consultation with obstetrician & gynaecologist  Antenatal care, delivery and postnatal care for high risk pregnancies (1 st pregnancy, multiple pregnancies, 4 th pregnancy and beyond, Pregnancy with superimposed medical conditions, etc)  Management of ectopic pregnancy  Caesarean section  Management of other gynecological conditions such as ovarian cyst, polycystic ovarian syndrome, etc  Management of infertility excluding assisted reproductive methods such as IVF, ICSI, etc.  Hysterectomy  Pelvic prolapse surgery  Other obstetric and gynecological conditions not in the exclusion list Obstetrics & Gygnaecological Services

12  Specialist consultation with an ophthalmologist  Management of eye conditions such as foreign body removal, pterygium excision, cataract extraction, glaucoma, etc.  Refraction  Other ophthalmological conditions not in the exclusion list Ophthalmological Services

13 Consultation with ENT surgeon Removal of foreign bodies Antral wash out Tonsillectomy Polypectomy Tracheotomy Adenoidectomy Any other procedure not in the exclusion list Ear, Nose & Throat (ENT) Services

14  Consultation with specialist  Management of Psychosis  Manic -Depressive illnesses  Schizophrenia, etc  Others conditions not on the exclusion list Mental Health Services

15  Tooth extraction and amalgam filling Dental Services

16  Consultation with a specialist  Palsies within 15 days following initial treatment  Post trauma rehabilitation  CVA therapy within 15 days  Post surgery rehabilitation within prescribed 15 days. Physiotherapy Services

17 Total Exclusions  Domiciliary visit  Medical check up unrelated to illness  Epidemics  Injuries resulting from: - natural disasters e.g earthquake, landslide, etc.  Conflicts, social unrest, riots, wars, etc.  Extreme sports e.g car racing, horse racing, polo, boxing, wrestling, etc.  Occupational/ industrial injuries( covered under the Workman Compensation Act)  Transplant and cosmetic surgeries  High cost surgical procedures  Organ transplant  Open heart surgery  Neurosurgery (excluding borehole)  Laminectomy, etc TOTAL EXCLUSION

18  High tech investigation except in life threatening emergencies, e.g CT Scan, MRI  Family planning commodities  Drug abuse/ addiction  Terminal illnesses including all cancers  Provision of spectacles, contact lens, etc.  Hearing aids and associated appliances  Management of Tuberculosis, Leprosy, Chronic renal failure  Congenital anomalies involving major/extensive surgical repairs, e.g separation siamese twins, omphalocoele, etc  Chronic congenital defects e.g Hirschsprung’s disease, etc  Management of infertility involving IVF, ICSI, etc  Dentures, crowns, bridges, implants, scaling and polishing  Maxillofacial surgeries  Root canal treatment

19  Life saving emergencies requiring high technology investigations (MRI, CT Scan, etc)  Screening e.g Pap smear, mammogram, etc  HMO pays 20% of the cost PARTIAL EXCLUSION


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